Associations between therapists' occupational burnout and their patients' depression and anxiety treatment outcomes

Engaging Ukrainian TF-CBT therapists in a PRACTICE skills course to support their wellbeing

Background: Burnout and secondary traumatic stress (STS) are common among therapists working with trauma-exposed clients, which can negatively impact them professionally and personally. The shared trauma of war exposure may put therapists at greater risk. To help support their wellbeing, an eight-session course was offered to Ukrainian therapists following training in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This course involves therapists personally utilizing the PRACTICE skills taught to clients in TF-CBT for professional and personal benefit.Objective: The objective was to gather preliminary evidence on the potential impact of implementing the course with Ukrainian therapists providing TF-CBT during a period of war in Ukraine. Specifically, this study examined if course participation was associated with increased PRACTICE coping skills usage, decreased burnout and STS, increased feelings of TF-CBT competency/confidence, and increased empathy for clients' experiences when implementing the skills.Method: The eight-session virtual course included cultural adaptations to increase its compatibility with Ukrainian culture. Thirteen matched pre-post course surveys were analysed to provide preliminary data on the course's effect on PRACTICE coping skills usage, burnout, and STS. The course's impact on therapist coping/wellbeing, TF-CBT competency/confidence, and empathy for clients was also examined qualitatively.Results: PRACTICE coping skills were utilized significantly more frequently at post-course compared to pre-course (p = .010). Therapists also reported lower average scores for burnout and STS after course completion, though these changes were not statistically significant. Most participants (92.3%) reported professional benefits from course participation including increased competency/confidence and empathy for clients. All therapists (100%) reported personal benefits from course participation including increased use of coping skills.Conclusions: Results indicate that participants experienced professional and personal benefits from course completion. This study provides helpful preliminary evidence of a positive impact, however, given the small sample size, larger scale implementation is needed.

Burnout syndrome in resident physicians: A study after the third COVID-19 wave in two tertiary hospitals of southeastern Brazil

BACKGROUND

In recent years, there has been an increase in the concern for the mental health of resident physicians. The COVID-19 pandemic may have further contributed negatively to the mental health of this population.

OBJECTIVES

We aimed to evaluate the probability of Burnout Syndrome in resident physicians involved in COVID-19 care services during the Pandemic and possible factors associated with it.

METHODS

A cross-sectional study was conducted in two tertiary hospitals in Belo Horizonte, Brazil, between the 5th of June and the 14th of September 2022. A survey including the instruments Oldenburg Burnout Inventory (OLBI), Depression, Anxiety and Stress Scale (DASS-21), Patient Health Questionnaire (PHQ-9), and the Brief Resilient Coping Scale (BRCS) was applied.

RESULTS

From the 181 resident physicians invited to participate, 104 agreed. The mean age (SD) was 29.9 (3.3) years; 56.7% were female, and 67.3% were from a clinical residency program. The score of the OLBI was high. In the multivariate analysis, being single, using psychiatric medications, and taking direct care of COVID-19 were associated with increases in the OLBI scale scores. The frequencies of probable depression and anxiety assessed by DASS-21 were 15.3% and 5.7%, respectively. Notwithstanding, the frequency of probable stress was 61.5%. Depressive symptoms, as evaluated by the PHQ-9 questionnaire, were highly prevalent at 61.5%. Further, 29% of the resident physicians interviewed in our study had probable low resilience according to the BRCS score.

CONCLUSION

The frequency of Burnout, depression, and stress found in our study appears to be relevant in the resident physicians.

Technostress and its associated factors: Burnout and fatigue among Malaysian healthcare workers (HCWs) in state hospitals

BACKGROUND

Technostress is defined as a psychological state associated with the increased usage of advanced computer technologies on a daily basis. It is also defined as an anxiety feeling or mental strain due to excessive exposure or involvement with technologies.

AIM

This study aimed to determine the level of technostress associated with burnout and fatigue among healthcare workers (HCWs) in the state hospitals of Malaysia.

METHODS

A cross-sectional study was conducted from September 2022 to November 2023 among HCWs working in the 15-state hospitals in Malaysia. A standardized questionnaire was distributed among the HCWs in the state hospitals in Malaysia. The questionnaire contains information on socio-demography and topic-specific scales on technostress, burnout and fatigue.

RESULTS

A total of 1620 HCWs were included in the analysis, of which 244 (15%) have high level of technostress, 1089 (67%) have moderate technostress, and 287 (18%) have low technostress. Burnout, and fatigue were significantly associated with technostress. HCWs with moderate burnout were less likely to have high technostress compared to those with high burnout (B =  -0.993, 95% CI; 0.231 - 0.594; p <  0.001). Those with moderate fatigue were less likely to have high technostress (B =  -3.844, 95% CI; 0.003 - 0.162; p <  0.001) compared to those with high fatigue.

CONCLUSIONS

This study found that majority of the HCWs have moderate level of technostress. Technostress has become more common after the COVID-19 pandemic in 2020 drastically altered working conditions and made remote work using information and communication technologies (ICT) a necessity rather than a luxury. Mitigation measures and programs that include psychological support for individuals who are struggling with the technostress and burnout are needed to overcome this issue.

Reactivity and stability in facial expressions as an indicator of therapeutic alliance strength

Objective Aspects of our emotional state are constantly being broadcast via our facial expressions. Psychotherapeutic theories highlight the importance of emotional dynamics between patients and therapists for an effective therapeutic relationship. Two emotional dynamics suggested by the literature are emotional reactivity (i.e., when one person is reacting to the other) and emotional stability (i.e., when a person has a tendency to remain in a given emotional state). Yet, little is known empirically about the association between these dynamics and the therapeutic alliance. This study investigates the association between the therapeutic alliance and the emotional dynamics of reactivity and stability, as manifested in the facial expressions of patients and therapists within the session. Methods: Ninety-four patients with major depressive disorder underwent short-term treatment for depression (N = 1256 sessions). Results: Both therapist reactivity and stability were associated with the alliance, across all time spans. Patient reactivity was associated with the alliance only in a short time span (1 s). Conclusions: These findings may potentially guide therapists in the field to attenuate not only their emotional reaction to their patients, but also their own unique presence in the therapy room.

An examination of therapists' professional characteristics as moderators of the effect of feedback on psychological treatment outcomes

Feedback-informed treatment (FIT) has been shown to reduce the gap between more and less effective therapists. This study aimed to examine therapists' professional characteristics as potential moderators of the effect of feedback on treatment outcomes.

The IAPT-FIT Trial was a clinical trial where therapists were randomly assigned to a FIT group or a usual care control group. Treatment response was monitored using measures of depression (PHQ-9), anxiety (GAD-7) and functional impairment (WSAS). In a secondary analysis of this trial (n = 1,835 patients; t = 67 therapists), we used multilevel modelling to examine interactions between therapists' professional characteristics (e.g., attitude towards and self-efficacy regarding feedback utilization, decision-making style, job satisfaction, burnout, difficulties in practice, coping styles, caseload size) with random allocation (FIT vs. controls) to identify moderators of the effects of feedback.

Between 9.6% and 10.8% of variability in treatment outcomes was attributable to therapist effects. Therapist-level caseload sizes and external feedback propensity (EFP) moderated the effect of feedback on depression outcomes. No statistically significant main effects were found for any of the included therapist characteristics.

FIT reduced variability in outcomes between therapists and was particularly effective for therapists with high EFP and larger caseloads.

Revealing the confluences of workplace bullying, suicidality, and their association with depression

This cross-sectional study analyzed data from 12,541 employees aged 19-65 across 26 companies and public institutions who underwent workplace mental health screening. Workplace bullying was self-reported and categorized into 'Not bullied,' 'Occasional bullied,' and 'Frequently bullied.' Depression was assessed using the Center for Epidemiological Studies Depression scale, and suicidality was measured via a self-reported questionnaire from the Korea National Health and Nutrition Examination Survey. Overall, 18.7% of women and 10.6% of men reported experiencing workplace bullying. Multivariable logistic regression revealed that both the occasionally and frequently bullied were significantly associated with increased odds of suicidal ideation (OR = 1.47, 95% CI = 1.27-1.69; OR = 1.81, 95% CI = 1.36-2.40) and suicide attempts (OR = 2.27, 95% CI = 1.34-3.85; OR = 4.43, 95% CI = 2.13-9.21). The association between bullying and suicidal ideation was significant for participants with and without depression (OR = 1.47, 95% CI = 1.28-1.69; OR = 1.86, 95% CI = 1.31-2.62). Men exhibited a stronger association (p for interaction < 0.001). Whether an individual later had depressive symptoms or not, higher exposure to workplace bullying was associated with higher suicidality risk. The study highlights the need for companies to screen for bullying and provide mental health resources to prevent workplace-related suicides.

Schwartz Rounds in Higher Education Settings: A Systematic Review of the Research with Recommendations

BACKGROUND

Higher education institutions (HEIs) have recently integrated Schwartz Rounds (Rounds) as innovative ways of supporting health professional students' reflective practice, interprofessional learning and compassionate care. Emerging evidence suggests that Rounds benefit students' shared sense of belonging and insight into emotional aspects of training and care, providing safe places to share experiences and reflect. Our review examines the current literature regarding health students' evaluation of Rounds in HEIs, exploring experiences and perceived benefits of participating. We consider methodological issues with the existing literature and propose ways of addressing these in future research.

METHODS

Systematic searches were conducted on EBSCO, PsycINFO, PubMed and ASSIA to identify available literature relating to Schwartz Rounds in higher education. Eight studies - six with a mixed method design and two qualitative - were included in the review. Study quality and risk of bias were assessed. Evaluation survey data and themes generated from qualitative responses were considered together and a narrative synthesis was constructed.

RESULTS

Despite challenges with differing measurements and scale usage, five themes were identified reflecting the experience and perceived benefits for students attending Rounds. Students highlighted the value of peer connection and communication; normalisation of emotions; collaborative reflection and self-awareness; and the relevance of Rounds in their daily work and patient care. Students also commented on barriers to participation including Rounds' multidisciplinary nature, their group size, and the presence of staff. The majority of students rated Rounds as excellent or exceptional and agreed they should be integrated into the curriculum.

CONCLUSIONS

Our findings on Schwartz Rounds in higher education suggest they support student reflective practice and confidence in providing compassionate, high-quality patient care. However, the quality of research in this area is mixed, reflecting the relatively recent integration of Rounds in Higher education, and the challenges of implementing and evaluating new interventions in educational settings.

Transforming the Effectiveness and Equity of a Psychological Therapy Service: A Case Study in the English NHS Talking Therapies Program

To work with a psychological therapies service to implement a recovery plan, as required by a government body, aimed at improving patient outcomes (effectiveness) and decreasing practitioner variability (equity). A case-study utilizing components of a learning health system, including nationally mandated patient outcome data, comprising three 18-month phases: (1) retrospective baseline; (2) improving patient outcomes (management-led); and (3) reducing practitioner variability (clinician-led). Primary analyses focused on 35 practitioners (NPR = 35) who were constant across the three phases and their patients in each phase (NPA = 930, 1226, 1217, respectively). Reliable improvement rates determined patient outcomes and multilevel modeling yielded practitioner effects. To test generalizability, results were compared to the whole practitioner sample for each phase: (1) NPR = 81, NPA = 1982; (2) NPR = 80, NPA = 2227; (3) NPR = 74, NPA = 2267. Ethical approval was granted by the Health Research Authority. Patient outcomes improved in successive phases for both the core and whole practitioner samples with the largest impact occurring in the management-led intervention. Practitioner variability decreased in successive phases in both the core and whole practitioner samples except in the management-led intervention of the whole sample. Compared with the management-led intervention, the practitioner-led intervention yielded a decrease in practitioner effect exceeding 60% in the core sample and approaching 50% in the whole sample. The implementation of multiple components of a learning health system can lead to improvements in both the effectiveness and equity of a psychological therapy service.

Shaping psychotherapy trainees' potential: insights from training program directors

The role of the therapist has received growing attention in psychotherapy research, suggesting that training effectiveness may also depend on the person of the trainees, with relevant implications in terms of candidate selection or tailoring training to the person. In the present study, we focused on how and how much psychotherapy training can be effective in fostering trainees' characteristics associated with successful therapists and contrast trainees' characteristics that could represent limitations as therapists. The aim was to explore training program directors' perspectives on individual trainees' limitations and strengths, and on the effectiveness of training in shaping successful therapists. To this aim, we interviewed 14 training program directors with different psychotherapy approaches. Audio recordings of these semi-structured interviews were transcribed verbatim and analysed using NVivo software. According to our findings, transversally to different psychotherapy approaches, trainees' self-awareness and the ability to embrace uncertainty were recognized as the main characteristics of good trainees. Four training elements were fre- quently mentioned by directors as effective in shaping trainees' development: experiential learning, the use of paradigm that pri- oritizes self-awareness (instead of technique-focused approaches), the centrality of supervision and inter-vision, the trainer-trainee relationship. These insights highlight the importance of trainees' self-awareness and the ability to embrace uncertainty as potential personal variables that may influence the effectiveness of future psychotherapists and suggest giving attention to experiential learning and training relationships as crucial elements of psychotherapists' development during the training.

Motivations to become psychotherapists: beyond the concept of the wounded healer

Motivations to become psychotherapists have long been associated with the concept of the wounded healer, which posits that practitioners entering the field of mental health often do so as a result of their own personal struggles and challenges. Early difficulties and wounds are seen as a source of healers' capacity to comprehend and promote the processes of recovery, fostering a deeper connection between the healer and the person seeking support. Nevertheless, other factors not directly linked with early adversities have been posited to have an influence on the development of motivations towards pursuing a career in the psychological field. The present work aimed to review available empirical literature on the motivations to become psychotherapists, encompassing the concept of the wounded healer as well as other possible factors shaping practitioners' career choice. Three main domains of motivations have been addressed within the wounded healer framework: dysfunctional caregiving, negative personal experiences in the family of origin, and other early relational issues. Additionally, two other main domains, namely self-oriented and altruistic motivations, have been identified, and the concept of the healing healer was proposed to underline both the self-oriented healing process that a person may undergo while becoming a therapist, as well as the altruistic attitude in providing healing care towards others. Results were discussed addressing possible links between conscious and unconscious motivations to become therapists as well as in terms of clinical implications for practitioners in the field of clinical psychology.

The Effects of Burnout, Team Support, and Perceived Leader Effectiveness on Career Intentions Among JAG Corps Personnel

INTRODUCTION

Destructive interpersonal relationships at work may result in negative feelings among employees that hinder personal and organizational productivity, which may also result in high levels of job disengagement and subsequent career turnover intentions. Leaders play a key role in creating work environments conducive to optimizing employee performance, organizational culture, and workplace well-being. Social support, which may include support from one's supervisor, colleagues, and loved ones, has been shown to reduce strains and perceived stressors at work. In the Army, the Judge Advocate General's Corps (JAGC) personnel have a unique position as lawyers and legal staff and have been shown to have high rates of burnout. To promote soldier health, well-being, and career longevity, it is important to understand the impact interpersonal relationships have on career intentions. The current study assesses the relationship between perceived leadership effectiveness and career intentions as moderated by burnout measured by job disengagement and team care activities in JAGC personnel.

MATERIALS AND METHODS

The Walter Reed Army Institute of Research conducted a survey to understand factors affecting the well-being of the JAGC's soldier and civilian personnel as requested by the JAGC. JAGC personnel were administered several questionnaires covering a range of work and mental health topics. Job disengagement, career intentions, team care activities, and general leadership were assessed. A total of 831 JAGC personnel completed the survey, the majority (92%) of which were soldiers. Among soldiers, first lieutenants and captains (∼49%) were the majority. The sample largely consisted of men (∼63%), White individuals (∼76%), married individuals, (70%), and individuals with graduate degrees (∼81%).

RESULTS

One in four participants (∼29%) experienced high levels of disengagement, with their work. Over two-thirds of participants agreed that their immediate supervisor is an effective leader. When asked about career intentions, the majority of JAGC participants (54%) indicated that they would probably or definitely stay in the JAGC until retirement. Ordinal logistic regressions were conducted to assess the relationship between perceived leader effectiveness and career intentions, assessing the main effects of job disengagement and team care activities, and the interactions between those variables. No interaction effects were found to be significant, but main effects for perceived leader effectiveness were significant.

CONCLUSIONS

JAGC personnel reported higher levels of job disengagement for those with career intentions that were undecided or definitely leaving the JAGC after their current obligation. Those who were engaged in more team care activities had lower levels of disengagement. While the majority of the JAGC participants indicated career intentions to stay in the JAGC until retirement, increasing perceived effectiveness of leaders could help increase attrition and career intentions to stay in the JAGC beyond one's current obligation.

Predictors of burnout, secondary traumatic stress, and compassion satisfaction among practitioners in Norwegian child advocacy centers

BACKGROUND

Practitioners at Child Advocacy Centers (CACs) are frequently exposed to indirect trauma through their job, yet there is a lack of knowledge on how this affects them emotionally.

OBJECTIVE

This study aimed to investigate the levels of burnout, secondary traumatic stress (STS), and compassion satisfaction among practitioners at Norwegian CACs, and possible individual or work-related predictors.

PARTICIPANTS AND SETTING

An electronic cross-sectional survey was sent to practitioners at Norwegian CACs. A total of 77 practitioners completed the survey (response rate 86.5 %).

METHODS

Variables were measured with the Professional Quality of Life Scale, the Multifactor Leadership Questionnaire, and questions on personal traumatic experiences, support, and supervision. Bivariate and multivariate mixed effects modeling analyses and logistic regression analyses were employed.

RESULTS

The results showed relatively low levels of burnout and STS, and high levels of compassion satisfaction, compared to other studies of child protective and child welfare professionals. Work-related factors, but not individual factors, were found to predict all three outcome variables: Burnout was predicted by transformational leadership (p = .002) and laissez-faire leadership (p = .012), secondary traumatic stress by case supervision (p = .001), and compassion satisfaction by transformational leadership (p < .000), laissez-faire leadership (p = .028), and personal supervision (p = .023).

CONCLUSIONS

The results indicate that transformational leadership and supervision may protect against burnout and STS and promote compassion satisfaction in practitioners working at CACs. The type of supervision may be relevant, as case-focused supervision predicted STS, while personal supervision predicted compassion satisfaction.

Burnout assessment among pharmacist-academic detailers at the US Veterans Health Administration

BACKGROUND

Burnout among clinical pharmacist practitioners has been well established, but not among those who perform academic detailing.

OBJECTIVES

To measure burnout among clinical pharmacist practitioners who perform academic detailing (pharmacist-academic detailers) at the United States Veterans Health Administration and compare the findings using 2 validated burnout instruments for healthcare professionals.

METHODS

A cross-sectional study design was performed to measure burnout in VHA pharmacist-academic detailers across all VA regions between April 2023 and May 2023. Burnout was measured using the Oldenburg Burnout Inventory (OLBI) and a validated single-item burnout measure (SIMB). OLBI has 2 domains (exhaustion and disengagement) and categorizes burnout into Low, Moderate, and High based on scores above or below 1 standard deviation (SD) of the mean. The validated SIMB categorized burnout as having a score of 3 or greater (range: 1-5). Interrater reliability testing between the OLBI and the SIMB at detecting burnout among pharmacist-academic detailers was performed using the kappa test. Correlation between the 2 burnout instruments was assessed using the Spearman rho test.

RESULTS

A total of 50 pharmacist-academic detailers completed the burnout survey. A large proportion of respondents had Moderate levels of burnout for the total (72%) burnout score, disengagement (64%) domain, and exhaustion (74%) domain. In total, 86% of pharmacist-academic detailers reported having Moderate to High levels of burnout on the total OLBI score. On the SIMB, a total of 14 (28%) pharmacist-academic detailers reported having one or more symptoms of burnout. Interrater reliability was considered poor/slight agreement between the OLBI and SIMB. Correlation between the 2 burnout instruments was considered moderately correlated (rho = 0.67, P < 0.001).

CONCLUSION

This study provides an empirical analysis of burnout among pharmacist-academic detailers; however, the ability to detect burnout among pharmacist-academic detailers may be impacted by the selection of burnout instrument used.

Burnout and Job Satisfaction among Lecturers in Public Universities in Enugu State, Nigeria

BACKGROUND

There is increasing awareness of burnout and job disaffection among many professions like health profession, teachers, armed personnel and lawyers. However not much has been studied about university lecturers.

AIM

To obtain the prevalence and determine predictors of burnout and job satisfaction among lecturers in public universities in Enugu State, Nigeria.

METHODS

It was a cross sectional analytical study. The participants were academic staff from University of Nigeria Nsukka and Enugu State University of Technology who met inclusion criteria. They were selected using multistage sampling technique. Data were collected using Oldenberg Burnout Inventory for burnout and Job Descriptive Index for job satisfaction.

RESULTS

A total of 392 lecturers were studied: The males were 221 (56.3%), and the modal age group was 41-50 years: 152 (38.8%). The majority were married 303 (77.3%) and had worked for ≤10 years (65.8%). The prevalence of burnout was 57.7%. In general, 150 (38.3%) had a high level of job satisfaction. However, in most facets, < 50% were satisfied. Most socio-demographic variables were not associated with either burnout or job satisfaction. There is significant association between burnout and job satisfaction. Almost all 205 (90.7%) who had burnout had low job satisfaction and this was statistically significant (p value = 0.011). Present work condition, pay, opportunities, supervision were used as predictors to level of burnout. Present condition of work was a significant contributor (p = < 0.001).

CONCLUSION

The prevalence of burnout was high and many had low to moderate job satisfaction. Most socio-demographic variables were not associated with burnout or job satisfaction. There was a negative association between job satisfaction and burnout.

The Development and Feasibility of a Novel Group Intervention to Support Helping Professionals in Metabolizing Suffering and Engaging Strengths: The CHRYSALIS Program

This feasibility study reports on the development and initial evaluation of a novel online intervention for helping professionals (HPs; i.e. mental health professionals, chaplains, clergy) designed to (a) address occupational hazards, such as burnout and vicarious traumatization, and (b) promote well-being and flourishing at work. In contrast with competency and self-care focused models, the CHRYSALIS (Catalyzing Helping Professionals' Resilience, VitalitY, Spirituality, Authentic Living, and Inner Strength) intervention centers the self of the provider, explores cultural and spiritual contexts, and attends to systemic challenges. As part of a larger randomized controlled trial evaluating two program formats, the group format entails eight online sessions exploring strengths that can promote well-being, including processing, relational, vitalizing, orienting, and agentic capacities. To pilot test this framework and establish proof of concept, this study analyzed data from 41 HPs who had been randomly assigned to the group condition and completed surveys at four time points. Quantitative results indicated significant reductions in vicarious traumatization and burnout as well as increased well-being and meaning in work. Qualitative results suggest the intervention fostered relational support, cultivated new perspectives, and increased engagement with strengths, positively impacting participants' work and navigation of caregiving systems. Feedback about cohesion and group dynamic challenges in an online format informed further program development. This study provides initial support for the feasibility and efficacy of the group format of the CHRYSALIS intervention as a creative means to address HPs' risk for occupational hazards and promote holistic formation in a relational context.

Role of Institutional Support for Evidence-Based Psychotherapy in Satisfaction and Burnout Among Veterans Affairs Therapists

OBJECTIVE

Burnout is widespread among psychotherapists and leads to negative mental and other health outcomes, absenteeism, and turnover. Job resources, including institutional support for evidence-based practices, can buffer against burnout and may improve satisfaction among therapists. The Veterans Health Administration (VHA) is the nation's largest integrated health system and employs 23,000 therapists, including psychologists, social workers, and counselors. The authors assessed associations between perceived institutional support for evidence-based treatment and satisfaction and burnout among VHA therapists.

METHODS

This analysis used data from the VHA's national 2018 Mental Health Provider Survey. Responding therapists (N=5,341) answered questions about the quality of mental health care and job satisfaction. Multilevel logistic regression models were used to predict burnout and satisfaction. The authors tested availability of evidence-based treatment and measurement-based care (MBC) as predictors; analyses were adjusted for therapist workload, demographic characteristics, and potential clustering by facility.

RESULTS

VHA therapists had less burnout and more job satisfaction when they perceived receiving institutional support for evidence-based psychotherapy (EBP) and MBC, irrespective of whether the analyses were adjusted for workload. Less difficulty in scheduling EBP was significantly associated with decreased likelihood of burnout (OR=0.83, p<0.001) and increased satisfaction (OR=1.09, p=0.008). Less difficulty ending psychotherapy was significantly associated with decreased likelihood of burnout (OR=0.89, p=0.002) and increased satisfaction (OR=1.12, p=0.004).

CONCLUSIONS

Support for evidence-based practices, including EBP and MBC, was closely linked to VHA therapists' satisfaction and burnout. Expanding support for therapists to provide evidence-based treatment may benefit therapists, patients, and the health care system.

Building resilience in the Improving Access to Psychological Therapy (IAPT) Psychological Wellbeing Practitioner (PWP) role: a qualitative grounded theory study

AIM

Staff retention, particularly in the Psychological Wellbeing Practitioner (PWP) workforce, has historically been challenging for Improving Access to Psychological Therapy (IAPT) services. This study sought to develop an explanatory model of the resilience-building process in PWPs working within the IAPT programme.

METHOD

A qualitative design was conducted, using a grounded theory methodology. Participants were recruited from two IAPT services in the National Health Service (NHS), which were part of the same Mental Health Trust. Ten PWPs were interviewed via videoconferencing using semi-structured interviews.

RESULTS

An explanatory model of resilience in PWPs encompassed three phases: the experience of work-related challenges, the connection with their values and the related appraisal of adversity in resilient ways, and the implementation of effective coping strategies.

CONCLUSIONS

The model highlights that PWPs develop resilience through values-based sensemaking and by proactively engaging in effective coping mechanisms. This study contributes to the current understanding of the process of resilience in PWPs. More research is needed to explore the developmental processes underlying PWPs' resilience. The implications of the findings in relation to existing conceptualisations of resilience, staff wellbeing and retention are explored. Recommendations for future research are also given.

Where it all begins: Predicting initial therapeutic skills before clinical training in cognitive behavior therapy

To train novice students adequately, it is crucial to understand where they start and how they develop their skills. This study examined the impact of novice students' characteristics on their initial clinical micro-skills when treating simulated patients with cognitive behavior therapy. The sample consisted of 44 graduate psychology students treating seven simulated patients. Clinical micro-skills were measured both using video-based ratings in reaction to short video clips of simulated patients (via the Facilitative Interpersonal Skills (FIS) performance task) and by using video-based ratings within a session with a simulated patient (using the Inventory of Therapeutic Interventions and Skills; ITIS). Two separate LASSO regressions were performed using machine learning to select potential predictors for both skills assessments. Subsequently, a bootstrapping algorithm with 10,000 iterations was used to examine the variability of regression coefficients. Using LASSO regression, we identified two predictors for clinical micro-skills in standardized scenarios: extraversion (b = 0.10) and resilience (b = 0.09), both were not significantly associated with clinical micro-skills. Together, they explained 15% of the skill variation. Bootstrapping confirmed the stability of these predictors. For clinical micro-skills in sessions, only competitiveness was excluded by LASSO regression, and all predictors showed significant instability. The results provide initial evidence that trainees' resilience and extraversion should be promoted in the clinical training of cognitive behavior therapy. More studies on clinical micro-skills and training with larger sample sizes are needed to fully understand clinical development.

Can Measurement-Based Care Reduce Burnout in Mental Health Clinicians?

Burnout is a syndrome characterized by mental and emotional fatigue or exhaustion, depersonalization, and a lessened sense of personal accomplishment and efficacy. Burnout leads to negative consequences for mental health clinicians and for mental health care organizations. Measurement-based care (MBC) is a clinical process in which clinicians and clients use patient-generated data, also called treatment feedback, to collaboratively monitor mental health care and to inform goal-setting and treatment planning. We propose that MBC may improve the experience of care for both clients and clinicians, and ultimately protect against each of the three components of burnout. When combined with other organizational changes, adoption of MBC may support organizational level efforts to reduce burnout in mental health services.

Burnout in trauma and orthopaedics: a cross-sectional study of surgeons from across the United Kingdom

INTRODUCTION

Improving psychological wellbeing in healthcare professionals has demonstrable links with improvements in system-performance and patient outcomes. The aims of this study were to determine the prevalence of burnout among orthopaedic surgeons within the United Kingdom (UK) and to identify any influencing factors.

METHODS

This prospective, cross-sectional nationwide study used the Oldenburg Burnout Inventory to assess burnout among orthopaedic registrars, middle grades and consultants from across the UK. In total, 369 participants completed an anonymised online survey. Reasons for burnout were assessed using a list of 20 stressors followed by a white-space box for elaboration.

RESULTS

Respondents included 204 (55.3%) consultants, 100 (27.1%) registrars and 65 (17.6%) who were an associate specialist, trust grade or fellow. Some 252 (68.3%) participants experienced moderate-level burnout and 81 (22.0%) high-level burnout. There was no significant association between burnout and grade (p = 0.283), gender (p = 0.433), marital status (p = 0.932), years since graduation (p = 0.397), overseas training (p = 0.642), hours worked (p = 0.601), region (p = 0.699) or hospital type (p = 0.813). A high level of disengagement and exhaustion were identified, with the latter being a greater contributory factor. The most common reasons for burnout were insufficient staff numbers, an overload of administrative work and limited time to see patients.

CONCLUSION

There was a moderate to high level of burnout among orthopaedic surgeons within the UK. Clinical and management teams should focus on improving staff numbers, reducing administrative work and increasing clinic consultation times to limit any further disengagement and exhaustion from surgeons. Reducing burnout may help to improve mental wellbeing, work satisfaction and workforce productivity.

The relationships between nurses' resilience, burnout, perceived organisational support and social support during the second wave of the COVID-19 pandemic: A quantitative cross-sectional survey

AIMS

To examine the level of resilience and burnout among British nurses during the second wave of the COVID-19 pandemic and the influence of personal, social and organisational factors on nurses' resilience and burnout.

BACKGROUND

Nurses experienced excessive workload and emotional demands over a prolonged period during the COVID-19 pandemic which may have led to exhaustion. Little research has examined the correlation between the pandemic variables, nurses' resilience and burnout during the second wave of the COVID-19 pandemic.

DESIGN

This study utilised a descriptive, cross-sectional research design.

METHODS

A cross-sectional and self-report survey involved 111 staff nurses, who completed a self-administrated questionnaire between January and April 2021. A STORBE checklist was used to report the study results.

FINDINGS

The study found that nurses experienced a high level of burnout and low to moderate levels of resilience. The study revealed significant negative relationships between the level of burnout and perceived organisational support and nurses' resilience. The impact of the COVID-19 pandemic on nurses' social roles and their worries about patient safety were positively correlated with burnout. The perceived organisational support, the impact of the COVID-19 pandemic on nurses' social roles and the level of resilience were significant factors for burnout.

CONCLUSIONS

Nurses experienced a high level of burnout during the second wave of the COVID-19 pandemic, which may be influenced by how they felt their organisations supported them. Nurses' feelings that the pandemic affected their social roles were associated with increasing their burnout.

RELEVANCE TO CLINICAL PRACTICE

Strategies should be developed to address staff burnout and resilience. Nurse managers and educators should play leadership roles in creating professional training to include competencies and psychological preparedness for disasters and to implement strategies to increase the organisational commitments to staff safety and well-being.

Practitioner Burnout and Productivity Levels in Skilled Nursing and Assisted Living Facilities, Part 1: A Descriptive Quantitative Account

IMPORTANCE

Understanding burnout among practitioners in skilled nursing facilities (SNFs) and assisted living facilities (ALFs) while considering contextual factors may lead to practices that enhance therapist and patient satisfaction as well as quality of care.

OBJECTIVE

To examine productivity standards and burnout in the context of setting and role, as reported by therapy practitioners in geriatric settings, and to explore relationships between productivity standards and perceived ethical pressures.

DESIGN

Cross-sectional online survey with descriptive data.

PARTICIPANTS

Practitioners (N = 366) included occupational therapists, physical therapists, speech-language pathologists, and occupational and physical therapy assistants working in SNFs and ALFs in the United States. A survey integrating the Maslach Burnout Inventory: Human Services Survey for Medical Personnel (MBI-HSS) and questions addressing demographics and contextual factors was distributed via social media.

RESULTS

Of 366 practitioners, 20.5% were burned out, exhibiting extreme scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) on the MBI-HSS. Significant relationships between productivity requirements and EE, DP, and PA, after accounting for covariates, were evident. Significant relationships between productivity standards and five of the six ethically questionable behaviors existed. Role affected productivity requirements, specifically between therapists and assistants, whereas setting did not.

CONCLUSIONS AND RELEVANCE

Productivity standards and related pressures are associated with concerning aspects of burnout among practitioners working in geriatric settings. Advocating for change in defining productivity and incorporating positive support in the work environment may assist in reducing burnout and turnover rates and improve patient satisfaction and care. Plain-Language Summary: This research highlights the prevalence of burnout and perceived pressures related to productivity requirements among occupational therapy practitioners working in skilled nursing and assisted living facilities.

Give until It Hurts: An Exploratory Analysis of Mental Health Workers' Wellness

BACKGROUND

The well-being of mental health professionals has been of growing concern due to the increasing rates of reported stress and burnout. Previous research suggests that the quality of life for mental health workers (MHWs) is at an increased risk due to clinical load, salary concerns, and lack of time for self-care activities outside of work. There is a lack of research regarding the wellness of MHWs (i.e., psychology graduate students, academic faculty, psychiatrists, and mental health counselors) and its relation to the workplace environment. This study examined job-related factors that impacted participants' social, emotional, and professional well-being.

METHODS

Participants were recruited via professional organization listservs and answered questions about their psychological health (Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9), support systems (Multidimensional Scale of Perceived Social Support), and three qualitative questions about what they enjoy or find challenging about their work and any barriers to engaging in self-care activities.

RESULTS

An inductive qualitative analysis of the qualitative questions and descriptive statistics are presented to provide context for their qualitative responses.

CONCLUSIONS

Institutions can better support their workers by creating outlets to teach their staff self-care strategies and practice these strategies at work.

Outcomes of psychological support skills training for cancer care staff: Skill acquisition, work engagement, mental wellbeing and burnout

OBJECTIVE

Psychological support skills training has the potential to improve both the ability of cancer staff to help their patients, and staff wellbeing. However, few recent studies have assessed both these outcomes or incorporated current developments in psychological skills training, such as deliberate practice, which includes the use of iterative, corrective feedback to identify and improve individualised skill deficits. No studies have evaluated the contribution that psychological skills training could make to cancer care staff wellbeing and expertise in the wake of the COVID-19 pandemic. This study aimed to evaluate staff skill acquisition and work-related wellbeing following psychological support skills training that applied deliberate practice principles.

METHOD

A 2-day training and monthly supervision was offered to 145 cancer care staff that focused on brief assessment and intervention skills for patients experiencing mental health problems after cancer diagnosis and treatment. Deliberate practice principles were used to focus training on skills practice and feedback, over technique description. Self-reported ability to perform key skills taught, staff mental wellbeing, work engagement, and burnout were assessed at baseline, 3-month and 8-month follow-up.

RESULTS

Significant improvements in skills, mental wellbeing, burnout and work engagement were reported at 8-month follow-up. Full engagement in both training sessions was predicted by poorer baseline mental wellbeing, more positive evaluation of initial training, supervision attendance, and shorter follow-up.

CONCLUSION

A 2-day psychological support skills training using deliberate practice principles may support improvement in staff skill, mental wellbeing, burnout and work engagement.

Surveying Early Intervention Providers to Identify Opportunities for Workforce Support to Strengthen Family-Centered Care

Traditional provider-to-child models of early intervention (EI) service provision have been increasingly replaced by service guidelines that promote a broader family-centered approach to support improvement in the child's primary area of delay. These guidelines include working directly with caregivers and addressing needs of the family that might impact a caregivers' capacity to engage in developmentally supportive interactions with children (e.g., caregiver distress). Knowledge of provider skills, practices, and attitudes would inform efforts to broaden and enhance practice in line with these guidelines. Within an academic-community partnership to support EI, we surveyed 88 providers in Miami and Boston about their usual practice, perceptions of their skills, general attitudes towards evidence-based practices, and interest in specific training opportunities. Findings indicated that providers spent more time working directly with children than caregivers. Providers reported high interest in training to manage caregiver distress, support preschool readiness, and align work with family culture. Negative overall attitudes towards using evidence-based interventions and provider exhaustion were related to less interest in obtaining training in culturally-responsive practice. Exhaustion also related to less interest in training on other topics that represent a broadened scope of care, including building warm parent-child relationships. Findings are informing efforts to design EI training opportunities to improve parent-provider relations, enhance parent-child interactions, and reduce caregiver stress.

Supporting Emotionally Exhausted Community Mental Health Therapists in Appropriately Adapting EBPs for Children and Adolescents

Evidence-based practices (EBPs) are often adapted during community implementation to improve EBP fit for clients and the service context. Augmenting EBPs with additional dosing and content may improve fit. However, reducing EBP content can reduce EBP effectiveness. Using multilevel regression models, this study examined whether supportive program climate and program-furnished EBP-specific implementation strategies (e.g., materials, ongoing training, in-house experts) are associated with augmenting and reducing adaptations, and whether therapist emotional exhaustion moderated these associations. Data were collected from surveys completed by 439 therapists from 102 programs 9 years after a system-driven EBP implementation initiative. Supportive program climate was associated with more augmenting adaptations. Emotional exhaustion was a significant moderator. When organizations used more EBP-specific implementation strategies, more emotionally exhausted therapists reduced EBPs less and less emotionally exhausted therapists augmented EBPs more. Findings provide guidance on how organizations can support appropriate EBP adaptations in spite of therapist emotional exhaustion.

Validation and Psychometric Properties of the German Operational and Organizational Police Stress Questionnaires

CONTEXT

Working in the police force is an operationally and organizationally stressful job. Suitable psychometric tools are needed to detect and study the psychosocial risks of these professionals. The original version contains 40 items, which may be too long for clinical use or as a research control measure. The main aim of this study is to validate the Police Stress Questionnaire (PSQ) in German. The secondary objective is to validate a shorter version.

METHOD

After translation and counter translation of the PSQ-G by a committee of experts, 10 participants pre-tested the comprehension of an intermediate version, allowing the development of a final version that was submitted to a psychometric validation plan with 2314 German-speaking officers. Structure, reliability, and convergent, divergent, and discriminant validities were tested for each sample.

RESULTS

The German version of the PSQ performed well psychometrically. We have created a short version of 14 items with good psychometric properties, 7 items for each subscale: operational stressors and organizational stressors.

CONCLUSION

This study validated a German version of the PSQ and provides a reliable measure of stress processes in the police force. A short version is now available.

Examining the links between burnout and suicidal ideation in diverse occupations

Introduction

It is uncertain whether burnout is associated with suicidal ideation among workers not in health care services. The aim of this study was to identify how burnout and suicidal ideation are linked among employees in various occupations and whether depression affects this link.

Methods

This cross-sectional study collected data from 12,083 participants aged 19-65 years from 25 companies and public institutions who underwent workplace mental health screening. Burnout and depression were assessed using both the Oldenburg Burnout Inventory and the Center for Epidemiologic Studies Depression Scale. Suicidal ideation was assessed by a self-rated questionnaire from the Korea National Health and Nutrition Examination Survey.

Results

Exhaustion but not the cynicism dimension of burnout was associated with increased odds of suicidal ideation after adjustment for depression and other covariates (odds ratio [OR] = 1.47, 95% CI = 1.26-1.72). The association of exhaustion with suicidal ideation was significant in both depressed (OR = 1.36, 95% CI = 1.14-1.61) and not depressed (OR = 1.77, 95% CI = 1.13-2.76) participants. In exhausted participants, insufficient job control, an unfavorable occupational climate, low educational level, and depression were associated with increased odds of suicidal ideation.

Conclusion

Exhaustion is linked with risk of suicidal ideation in employees not in health care service, regardless of depression status. Exhausted employees, particularly those having poor job resources, should be recognized as an at-risk group.

Burnout among academic nursing faculty

BACKGROUND

Nurse faculty burnout is a growing concern in the United States. There are limited studies exploring the level of burnout in nursing faculty.

PURPOSE

To assess the prevalence of burnout among nurse faculty in undergraduate and graduate programs and its relationship with specific demographic and organizational variables.

METHODS

A descriptive cross-sectional research design was employed to examine the level of burnout of nursing faculty. An internet-based survey was administered to nursing faculty in over 1000 schools of nursing in the United States. Burnout was measured using the Oldenburg Burnout Inventory.

RESULTS

A total of 3556 surveys were returned. Among all participants, most of the sample exhibited moderate levels of burnout, exhaustion, and disengagement. Based on the findings from the OBI, a moderate/high exhaustion level was reported in 85.5 % of participants, while disengagement was moderate/high in 84.9 %, and overall burnout was at moderate/high levels in 85.2 % of the nursing faculty.

CONCLUSIONS

The nation's nurse faculty population is experiencing a moderate to high level of burnout, exhaustion, and disengagement. Academic nursing leaders are encouraged to identify ways and take action to reduce faculty burnout and promote faculty wellness and resilience.

Behavioral Health Provider Burnout and Mental Health Care in the Veterans Health Administration

BACKGROUND

Although many studies assess predictors of provider burnout, few analyses provide high-quality, consistent evidence on the impact of provider burnout on patient outcomes exist, particularly among behavioral health providers (BHPs).

OBJECTIVE

To assess the impact of burnout among psychiatrists, psychologists, and social workers on access-related quality measures in the Veterans Health Administration (VHA).

DESIGN

This study used burnout in VA All Employee Survey (AES) and Mental Health Provider Survey (MHPS) data to predict metrics assessed by the Strategic Analytics for Improvement and Learning Value, Mental Health Domain (MH-SAIL), VHA's quality monitoring system. The study used prior year (2014-2018) facility-level burnout proportion among BHPs to predict subsequent year (2015-2019) facility-level MH-SAIL domain scores. Analyses used multiple regression models, adjusting for facility characteristics, including BHP staffing and productivity.

PARTICIPANTS

Psychologists, psychiatrists, and social workers who responded to the AES and MHPS at 127 VHA facilities.

MAIN MEASURES

Four compositive outcomes included two objective measures (population coverage, continuity of care), one subjective measure (experience of care), and one composite measure of the former three measures (mental health domain quality).

KEY RESULTS

Adjusted analyses showed prior year burnout generally had no impact on population coverage, continuity of care, and patient experiences of care but had a negative impact on provider experiences of care consistently across 5 years (p < 0.001). Pooled across years, a 5% higher facility-level burnout in AES and MHPS had a 0.05 and 0.09 standard deviation worse facility experiences of care from the prior year, respectively.

CONCLUSIONS

Burnout had a significant negative impact on provider-reported experiential outcome measures. This analysis showed that burnout had a negative effect on subjective but not on objective quality measures of Veteran access to care, which could inform future policies and interventions regarding provider burnout.

"It's real. It's a thing:" Mental health counselors' listening exhaustion during COVID-19

Mental health counselors regularly use active listening skills to be present with each client; however, active listening may cause burnout due to high emotional labor, inadequate staffing, excessive workload, and many other issues, each of which contributes to career exits. COVID-19 exacerbated all of these factors, and-adding to already stressful conditions-most mental health professionals were forced to conduct therapy sessions via telehealth. For this study, twenty licensed mental health counselors at various stages of their careers were interviewed during the height of the pandemic to understand their experiences with the technology and other factors related to their workload during that time. Thematic qualitative analysis was used to explore effects of active listening-including requisite adjustments made for virtual therapy sessions-on counselors' emotional exhaustion and burnout levels. Results show how back-to-back, daily therapy sessions increased listening exhaustion levels and that counselors experienced both long-term and short-term listening exhaustion when utilizing telehealth due to lack of nonverbal cues and other related factors pertaining to online delivery. Implications for counselors, social workers, and other mental health professionals are discussed.

Determining the Best Approach: Comparing and Contrasting the Impact of Different Coping Strategies on Work-Related Stress and Burnout Among Saudi Commercial Pilots

Background Many physiological, psychological, and environmental stressors can be experienced by pilots throughout their careers, which may affect their mental and psychological health and their performance consequently. Stressing factors of aviation and commercial operations can result in pilots' burnout, which is a description of the response to chronic emotional exhaustion and loss of motivation. Objective The objective of this study was to determine the prevalence of burnout and compare the effects of different coping strategies on burnout levels among commercial pilots in the Kingdom of Saudi Arabia, 2023 Methods The study was a cross-sectional survey utilizing an online form of a validated questionnaire administered to pilots of Saudi commercial airlines in the Kingdom of Saudi Arabia. The study targeted on-duty Saudi commercial pilots, excluding retired and in-training pilots, with an estimated population of around 2000. A sample size of 311 was determined using an equation considering a 5% margin of error, 95% confidence level, and a 60.3% burnout prevalence rate. Non-probability snowball sampling method was used to achieve sample size. Results A total of 321 pilots were included, mostly Saudis. The participants had a median age of 47, and the majority were married with one to two children. BMI classifications showed high percentages of overweight and obese individuals. The study found that most pilots experienced medium levels of burnout (70.1%). Nationality, marital status, and shorter sleeping duration were significantly associated with higher burnout levels. Common challenges included long duties (79.4%), irregular working hours (72.3%), and time away from home (55.5%). Coping strategies included rest and sleep (81%), exercise (59.2%), and relaxation behaviors (50.5%). Stressors such as long duties, irregular working hours, and work conflicts were significantly associated with higher burnout levels. However, no significant associations were found between coping strategies and burnout levels. Conclusion The study found that most pilots experienced medium levels of burnout. In addition, common challenges included long duties, irregular working hours, and time away from home. The study emphasizes the need to address work-related stressors, implement interventions, and support pilots' mental health. Promoting healthy coping strategies and understanding individual resilience is important. Further research and organizational efforts are required to mitigate burnout and enhance the quality of life for aviation professionals, benefiting both individuals and the industry.

Vicarious Post-traumatic Growth in Professionals Exposed to Traumatogenic Material: A Systematic Literature Review

Repeated exposure to traumatogenic material as part of work with traumatised individuals can have detrimental effects on professionals' well-being. Growing research has explored this phenomenon, known as 'vicarious traumatisation'. Nevertheless, little research has focused on the positive effects of this work on professionals, namely, 'vicarious post-traumatic growth'. This literature review aims to identify existing research demonstrating mental health professionals' experiences of growth, along with environmental and personal factors that facilitate this growth. Eight qualitative and seven quantitative articles were identified following a systematic search of six electronic databases and assessed for their quality using standardised checklists. Qualitative studies were assessed using the Quality Appraisal Checklist for Qualitative Studies (NICE, 2012), and quantitative studies were assessed using the Appraisal Tool for Cross-Sectional Studies (Downes et al., 2016). Professionals described changes in the way they view themselves, the value they place on their relationships and their appreciation for life. Important organisational factors and personal traits were identified as significant predictors for professionals' growth. Our findings have the potential to inform practical recommendations and directions for future research.

A randomized-controlled trial of a digital, small incentive-based intervention for working adults with short sleep

STUDY OBJECTIVES

We evaluated the efficacy of a digitally delivered, small and scalable incentive-based intervention program on sleep and wellbeing in short-sleeping, working adults.

METHODS

A 22-week, parallel-group, randomized-controlled trial was conducted on 21-40 y participants gifted with FitbitTM devices to measure sleep for ≥2 years, as part of a broader healthy lifestyle study. About 225 short sleepers (141 males; average time-in-bed, TIB < 7h) were randomly assigned in a 2:1 ratio to Goal-Setting or Control groups. The Goal-Setting group received health vouchers (~USD 0.24) for meeting each sleep goal (i.e. increasing weeknight TIB by 30 min/sleeping before midnight).The study spanned three phases: (1) 2-week Baseline, (2) 10-week Intervention, and (3) 10-week Follow-Up. Wellbeing questionnaires were administered on Weeks 1-2, 11-12, and 21-22.

RESULTS

Baseline weeknight TIB (mean ± SD) was 387 ± 43 min (Goal-Setting) and 399 ± 44 min (Control), while bedtime was 00:53 ± 01:13 (Goal-Setting), and 00:38 ± 00:56 (Control). No difference in sleep outcomes was observed at study endpoints, but exploratory week-by-week analysis showed that on Weeks 3-5, TIB in the Goal-Setting group increased (9-18 min; ps < 0.05) while on Week 5, bedtimes shifted earlier (15 min; p < 0.01) compared to Baseline. Morning sleepiness was reduced in the Goal-Setting group (mean[SEM] = -3.17(1.53); p = 0.04) compared to Baseline, although between-group differences were not significant (p = 0.62). Main barriers to sleeping longer were work hours (35%), followed by leisure activities (23%) and family commitments (22%).

CONCLUSION

Our program resulted in encouraging subjective sleep improvements and short-term sleep extension, but sustained transformation of sleep will probably require structural measures to overcome significant obstacles to sleep.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04878380 (hiSG Sleep Health Study (hiSG-SHS); https://clinicaltrials.gov/ct2/show/NCT04878380).

Pragmatic randomized controlled trial of the Mind Management Skills for Life Programme as an intervention for occupational burnout in mental healthcare professionals

BACKGROUND

Occupational burnout is highly prevalent in the mental healthcare workforce and associated with poorer job satisfaction, performance and outcomes.

AIMS

To evaluate the effects of the Mind Management Skills for Life Programme on burnout and wellbeing.

METHODS

N = 173 mental health nurses were recruited from the English National Health Service during the acute phase of the COVID-19 crisis. Participants were allocated to an immediate intervention or a delayed intervention control group, using a stepped wedge randomized controlled trial design. Measures of burnout (OLBI) and wellbeing (WEMWBS) were completed at four time-points: [1] baseline; [2] after the first group finished the intervention; [3] after the second group finished the intervention; and [4] six-months follow-up.

RESULTS

Between-group differences were compared at each time-point using ANCOVA adjusting for baseline severity. Statistically significant effects on burnout (d = 0.60) and wellbeing (d = -0.62) were found at time-point 2, favouring the intervention relative to waitlist control. No significant differences were found at subsequent time-points, indicating that both groups improved and maintained their gains after the intervention.

CONCLUSIONS

This intervention led to moderate improvements in burnout and wellbeing, despite the adverse circumstances of the COVID-19 pandemic at the time of the study.

Correlation between psychological resilience and burnout syndrome in oncologists amid the Covid-19 pandemic

PURPOSE

Oncologists are predisposed to developing burnout syndrome. Like other health care professionals worldwide, oncologists have endured additional, extreme challenges during the Covid-19 pandemic. Psychological resilience presents a potential protective mechanism against burnout. This cross-sectional study examines whether psychological resilience eased burnout syndrome among Croatian oncologists during the pandemic.

METHODS

An anonymized self-reporting questionnaire was electronically distributed by the Croatian Society for Medical Oncology to 130 specialist and resident oncologists working in hospitals. Available for completion from September 6-24, 2021, the survey comprised demographic questions; the Oldenburg Burnout Inventory (OLBI), covering exhaustion and disengagement; and the Brief Resilience Scale (BRS). The response rate was 57.7%.

RESULTS

Burnout was moderate or high for 86% of respondents, while 77% had moderate or high psychological resilience. Psychological resilience was significantly negatively correlated with the OLBI exhaustion subscale (r =  - .54; p < 0.001) and the overall OLBI score (r =  - .46; p < 0.001). Scheffe's post hoc test showed that oncologists with high resilience scored significantly lower on the overall OLBI (M = 2.89; SD = 0.487) compared to oncologists with low resilience (M = 2.52; SD = 0.493).

CONCLUSION

The findings thus indicate that oncologists with high psychological resilience are at significantly lower risk of developing burnout syndrome. Accordingly, convenient measures to encourage psychological resilience in oncologists should be identified and implemented.

Therapist Interpersonal Behavior: An Investigation of Various Constructs and Underlying Abilities

<b><i>Objective:</i></b> Psychotherapists differ in their treatment effectiveness as measured by the therapy outcome of their patients. One possible factor for therapist effects seems to be the therapists’ interpersonal skills. Therapist assessments of interpersonal skills have demonstrated sufficient predictive validity, but little is known about underlying skills and related constructs. The purpose of the present study is to compare the different constructs of interpersonal skills with each other and to investigate possible underlying abilities. <b><i>Study Population and Methods:</i></b> In this exploratory study, the concept of interpersonal skills was investigated using three survey methods (questionnaires, computer tests, and assessments) and comparing two measurements each. For this purpose, 6 measures of interpersonal skills were collected from 20 prospective psychotherapists as well as 28 psychology students (total <i>N</i> = 48). Alongside more traditional methods, the correlations and overlaps of the constructs were examined using partial and Bayesian networks. <b><i>Results:</i></b> Moderate to high correlations are found within the self-report measures. The assessments, however, did not correlate with self-report measures nor with computer tests. <b><i>Discussion and Conclusion:</i></b> The similarities in the self-assessments indicate stable self-concepts of interpersonal skills, which, however, cannot be explained by the underlying skills nor by the observer-based evaluations. The marginal correlation between the assessments also indicates that interpersonal, therapy-related abilities must be interpreted in a situation-specific manner.

Attachment anxiety, reflective functioning and well-being as predictors of burn-out and psychological distress among psychotherapists: A longitudinal study

OBJECTIVE

This study aims to longitudinally investigate the effects of individual's factors on subsequent burn-out/psychological distress in a sample of mental health practitioners, testing if higher attachment anxiety and avoidance and lower reflective functioning (i.e., certainty and uncertainty of mental states) and well-being at baseline may lead to a greater psychological distress and burn-out 1 year later.

METHODS

The sample consisted of 40 experienced psychotherapists (females: 72.5%; mean age: 47.40 ± 9.48 years) who completed a battery of questionnaires at baseline and 1 year later. Statistical analyses were conducted with Bayesian multiple linear regressions.

RESULTS

Greater attachment anxiety and certainty about mental states and lower individual's well-being at baseline predicted greater burn-out 1 year later. Similarly, greater attachment anxiety and lower individual's well-being at baseline predicted psychological distress at 1 year follow-up. Of note, uncertainty of mental states and avoidant attachment were not associated with outcomes.

CONCLUSION

These findings suggest that the levels of burn-out and psychological distress among psychotherapists may be alleviated with interventions targeting attachment insecurity, specific aspects of reflective functioning (i.e., certainty about mental states) and well-being.

Implementation context and burnout among Department of Veterans Affairs psychotherapists prior to and during the COVID-19 pandemic

BACKGROUND

The first goal of this study was to assess longitudinal changes in burnout among psychotherapists prior to (T1) and during the COVID-19 pandemic (T2). The second objective was to assess the effects of job demands, job resources (including organizational support for evidence-based psychotherapies, or EBPs) and pandemic-related stress (T2 only) on burnout.

METHOD

Psychotherapists providing EBPs for posttraumatic stress disorder in U.S. Department of Veterans Affairs (VA) facilities completed surveys assessing burnout, job resources, and job demands prior to (T1; n = 346) and during (T2; n = 193) the COVID-19 pandemic.

RESULTS

Burnout prevalence increased from 40 % at T1 to 56 % at T2 (p < .001). At T1, stronger implementation climate and implementation leadership (p < .001) and provision of only cognitive processing therapy (rather than use of prolonged exposure therapy or both treatments; p < .05) reduced burnout risk. Risk factors for burnout at T2 included T1 burnout, pandemic-related stress, less control over when and how to deliver EBPs, being female, and being a psychologist rather than social worker (p < .02). Implementation leadership did not reduce risk of burnout at T2.

LIMITATIONS

This study involved staff not directly involved in treating COVID-19, in a healthcare system poised to transition to telehealth delivery.

CONCLUSION

Organizational support for using EBPs reduced burnout risk prior to but not during the pandemic. Pandemic related stress rather than increased work demands contributed to elevated burnout during the pandemic. A comprehensive approach to reducing burnout must address the effects of both work demands and personal stressors.

A scoping review of the literature pertaining to burnout and leadership in mental health clinicians

PURPOSE

This paper aims to explore what is known in the literature about leadership and burnout within mental health clinicians (MHC).

DESIGN/METHODOLOGY/APPROACH

The Arksey and O'Malley (2005) framework was used to conduct a systematised scoping review of three databases: PsycInfo, PubMed and CINAHL. To ensure a broad scope of the literature, Google, Google Scholar and three sources of grey literature were also searched.

FINDINGS

In total 1,087 articles were identified and 36 were included in the final review, 23 of which were cross-sectional and correlational studies. There is a lack of experimental studies, longitudinal research and qualitative approaches. The literature repeatedly demonstrated an association between leadership and burnout; transformational-leadership style, good quality supervision, supportive relationships, positive communication and fostering autonomy are areas of interest.

RESEARCH LIMITATIONS/IMPLICATIONS

Future research activity should aim to follow the recommendations made in the literature; more experimental and longitudinal approaches are needed to support practical application of the findings.

ORIGINALITY/VALUE

To the best of the author's knowledge there is no other review which maps out the research pertaining to leadership and burnout among MHC. These findings can be used to guide future research to ensure that efforts are directed toward original, meaningful and practical ventures that will add to the evidence base and benefit clinical practice.

High prevalence of burnout syndrome among medical and nonmedical residents during the COVID-19 pandemic

BACKGROUND

Since the beginning of the COVID-19 pandemic, health professionals have been working under extreme conditions, increasing the risk of physical and mental illness. We evaluated the prevalence of burnout and its associated factors among postgraduate student residents in health professions during the global health crisis.

METHODS

Healthcare residents were recruited from all across Brazil between July and September 2020 through digital forms containing instruments for assessing burnout (Oldenburg Burnout Inventory (OLBI)), resilience (brief resilient coping scale (BRCS)) and anxiety, stress and depression (depression, anxiety and stress scale (DASS-21) and Patient Health Questionnaire (PHQ-9)). Additionally, the relationships between burnout and chronic diseases, autonomy and educational adequacy in the residency programme, personal protective equipment (PPE), workload and care for patients with COVID-19 were evaluated. The chi-square test, Student's t test, Pearson's correlation test and logistic regression were performed.

RESULTS

A total of 1,313 participants were included: mean (standard deviation) age, 27.8 (4.4) years; female gender, 78.1%; white race, 59.3%; and physicians, 51.3%. The overall prevalence of burnout was 33.4%. The odds (odds ratio [95% confidence interval]) of burnout were higher in the presence of pre-existing diseases (1.76 [1.26-2.47]) and weekly work > 60 h (1.36 [1.03-1.79]) and were lower in the presence of high resilience (0.84 [0.81-0.88]), autonomy (0.87 [0.81-0.93]), and educational structure (0.77 [0.73-0.82]), adequate availability of PPE (0.72 [0.63-0.83]) and non-white race (0.63 [0.47-0.83]). Burnout was correlated with anxiety (r = 0.47; p < 0.05), stress (r: 0.58; p < 0.05) and depression (r: 0.65; p < 0.05).

CONCLUSIONS

We observed a high prevalence of burnout among residents during the COVID-19 pandemic. Individual characteristics and conditions related to the work environment were associated with a higher or lower occurrence of the syndrome.

Self-compassion, coping strategies and gender differences in psychology, counselling and psychotherapy practitioners during COVID-19: Lessons learnt

Effective coping strategies can protect against the adverse effects of stress. This study investigated self-compassion's ability to predict approach and avoidance coping in psychology, counselling and psychotherapy practitioners (PCPPs) during COVID-19, and whether this differed between genders. To date, no research has investigated this relationship, despite positive associations being drawn in other populations. Three hundred and nineteen PCPPs completed an online survey including the Brief COPE and Self-Compassion Short Form. Self-compassion significantly predicted greater use of approach coping and reduced use of avoidance coping. The predictive ability of self-compassion was slightly better in female practitioners. Self-judgement arose as a prominent subscale of self-compassion across genders, increasing both approach and avoidance coping. Implications for future research and practice are discussed, concerning barriers to self-compassion and the requirement of therapeutic programmes and psychoeducation as a prerequisite for effective coping strategies in the PCPP population.

The risk of burnout in academic radiographers during the COVID-19 pandemic

Introduction

The COVID-19 pandemic created major challenges across society, healthcare provision and also for those delivering healthcare education programmes. Clinical placements were disrupted and, in many incidences cancelled. Higher education institutions were required to move completely to online delivery methods with little notice. This created significant additional workload, stress and the need to learn new skills at a time of great uncertainty. This study explored the risks of burnout in academic radiographers during the first 12 months of the pandemic.

Methods

A survey was circulated using SurveyMonkey™ via personal, national and international networks, including the European Federation of Radiographer Societies (EFRS), to reach as many academic radiographers as possible. Disengagement and exhaustion were measured using the Oldenburg burnout inventory. Descriptive statistics and a one-way ANOVA were used to analyse the quantitative data using STATA V16 (Statacorp, TA).

Results

533 academic radiographers responded to the survey from 43 different countries. Mean disengagement was in the medium range and exhaustion was high for the total dataset. In a subset of countries with 10 or more responses, there was significant variation between countries, with the UK having highest mean exhaustion score and the UK, Ireland and France sharing the highest mean disengagement score. In the total dataset, 86% agreed workload had increased during the pandemic and 35% had considered leaving academia in the last year.

Conclusion

These data demonstrate the stark reality of the impact of the COVID-19 pandemic on academic radiographers’ workload, wellbeing, and intention to leave their roles.

Implications for practice

COVID-19 has had a significant impact on academic radiographers and this study highlights the urgent need for remedial measures to better support academic radiographers in order to ensure a sufficient, and sustainable workforce.

What about the therapist? – a quantitative exploration of the pathways from a therapist’s professional life to their personal well-being

Occupational stress has been identified as one of the biggest contributors to therapists’ poor mental well-being; however, these ‘wear and tear’ effects are not universal. This study aimed to distinguish between these experiences, by exploring potential avenues through which a therapist’s professional life may impact their well-being. Previous research has highlighted four avenues: self-doubt, developmental depletion, developmental growth, and years of experience. A sample of 65 cognitive behavioural therapists were recruited from four Improving Access to Psychological Therapies (IAPT) services and a cognitive behavioural therapy training course at Buckinghamshire New University. A quantitative cross-sectional survey design was employed. Each participant completed a questionnaire consisting of subscales of the ‘Development of Psychotherapist Common Core Questionnaire’ to measure potential avenues (Orlinsky et al., 1999a), and the Warwick-Edinburgh Mental Well-being Scale to measure mental well-being (Tennant et al., 2007). A multiple regression and post-hoc mediation analyses were conducted. The multiple regression analysis found three significant direct pathways predicting well-being: self-doubt, developmental depletion, and developmental growth. The post-hoc mediation analyses found two significant indirect pathways between self-doubt and well-being mediated by developmental experience (growth and depletion). Years of experience had a non-significant direct and indirect pathway predicting well-being. The results suggested that therapists experiencing more growth, less depletion and less self-doubt experienced more positive mental well-being than those experiencing depletion and self-doubt, and less growth. When therapists experience high self-doubt, whether they also experience depletion or growth, they experience poor mental well-being. The implications for practice and future avenues of research are discussed.

Key learning aims

(1)

Job Satisfaction and Burnout in Croatian Physiotherapists

BACKGROUND

Physiotherapists are important healthcare professionals in modern and multidisciplinary health forces. However, they are exposed to a high risk of occupational burnout, which is associated with reduced job satisfaction. Job satisfaction is essential for medical professionals because it directly influences patient safety and the quality of medical care. Therefore, this study aimed to determine the association between sociodemographic variables of Croatian physiotherapists, job satisfaction, and occupational burnout.

METHODS

A cross-sectional study was performed among 404 physiotherapists using a sociodemographic questionnaire, the Job Descriptive Index (JDI), and Oldenburg Burnout Inventory (OLBI).

RESULTS

The study group of Croatian physiotherapists was marked by a high level of job satisfaction and occupational burnout. However, a higher level of occupational burnout is associated with lower job satisfaction. The main determinants of job satisfaction were younger age, female gender, less work experience, and married or partnership. At the same time, a higher level of occupational burnout was associated with working in government institutions and being single.

CONCLUSIONS

As a reaction to psychological stress at work with the main components of exhaustion and disengagement, occupational burnout is negatively associated with job satisfaction. Therefore, assessing the factors influencing job satisfaction and burnout in the workplace can help develop physiotherapists' mental health prevention strategies.

Psychotherapist Trainees' Quality of Life: Patterns and Correlates

While psychotherapists are trained to improve their clients' quality of life, little work has examined the quality of life experienced by psychotherapist trainees themselves. Yet their life satisfactions and stresses would plausibly affect both their ability to learn new skills and conduct psychotherapy. Therefore, in the Society for Psychotherapy Research Interest Section on Psychotherapist Development and Training study, we investigated the patterns of self-reported life quality and their correlates in a multinational sample of 1,214 psychotherapist trainees. A comprehensive questionnaire was used at the outset of trainings to assess trainees' professional background, current life situation, personal characteristics, family background, and social and national origin. The findings indicated 54.3% of trainees' lives could be characterized as fortunate or happy (i.e., experiencing great life satisfaction and not much stress), whereas 14.3% could be characterized as clearly distressed or troubled (i.e., experiencing great life stress and not much satisfaction). The strongest correlates of high life stress, a contributor to poor life quality, were economic insecurity, self-protectiveness, and attachment-related anxiety in relationships, and economic or psychological hardship in childhood. In turn, greater wellbeing was most strongly associated with a warm and open interpersonal style, being married, having sufficient economic means, and material and emotional security in childhood. While the results indicate the majority of therapists experience a relatively good quality of life, the findings also suggest potential targets for increasing trainees' life quality when it may be deficient, such as those on a societal level (e.g., availability of low-cost student loans), training program level (e.g., promoting supportive supervision, positive between-trainee relationships and group collaboration), and individual level (e.g., personal therapy and learning self-care), in order to promote effective learning and therapy practice.

Real-World Evaluation of a Large-Scale Blended Care-Cognitive Behavioral Therapy Program for Symptoms of Anxiety and Depression

Introduction: Prior studies have supported the effectiveness of blended interventions for anxiety and depression; however, outcomes research of large-scale blended interventions for these conditions is limited. Objective: To investigate the outcomes of scaled-up blended care (BC) cognitive behavioral therapy (CBT), a program that combined video-based psychotherapy with internet CBT, for symptoms of anxiety and depression. Materials and Methods: Participants were 6,738 U.S.-based adults with elevated symptoms of anxiety (Generalized Anxiety Disorder-7 [GAD-7] ≥ 8) and/or depression (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) at baseline who received BC-CBT as an employer-offered mental health benefit. The primary outcomes, anxiety (GAD-7) and depression (PHQ-9) symptoms, were routinely measured in the program. Recovery and reliable improvement in outcomes were calculated, and growth curve models evaluated change in outcomes during treatment and the effects of engaging in psychotherapy sessions on outcomes. Results: On average, participants received treatment for 7.6 (standard deviation = 6.2) weeks. By the end of care, 5,491 (81.5%) participants had reliable improvement in either anxiety or depression symptoms; in addition, 5,535 (82.1%) fell below the clinical threshold for either anxiety or depression symptoms (i.e., recovered). Declines in anxiety and depression symptoms were statistically significant over the course of BC-CBT (both p's < 0.01), with the rate of decline significantly decreasing for each outcome as treatment progressed (both p's < 0.01). Each psychotherapy session completed was significantly associated with lower anxiety and depression symptoms during the week of the session and the subsequent week (all p's < 0.01). Conclusions: This real-world study provides evidence that scaled-up BC-CBT can be effective in the treatment of symptoms of anxiety and depression.

Evaluating Advanced Practice Nurses' Burnout and Potential Helping Modalities

Health care providers are experiencing increased stress during the coronavirus disease 2019 pandemic. While it is understood that increased stress leads to burnout, limited research has been conducted to evaluate advance practice nurse response to coronavirus disease 2019, and more specifically, self-identified modalities that may decrease stress in the workplace or at home. This pilot study evaluated advance practice nurse-perceived burnout and evaluated perceived needs and/or perception of modalities aimed at reducing stress and improving well-being, such as essential oils, quiet room, soothing music, art therapy, pet therapy, and mobile applications, that could be easily accessed in the workplace.